为了减少急性住院儿童和青少年精神科的胁迫,需要更好地了解处于隔离和/或约束(S/R)风险的个人。我们报告了有关隔离/限制患者比例以及与S/R高风险相关的因素的数据。通过住院时的风险分层确定预防机制可以帮助培训心理健康专业人员,并支持为处于危险中的人群制定具体的工作流程,例如通过联合危机计划或胁迫后的审查会议。
方法:一项病例对照研究包括2019年至2022年36个月内儿童和青少年精神科的所有入院(n=782)。年龄数据,性别,离开家庭护理,主要和共病ICD-10诊断,逗留时间,使用分类卡方检验和连续变量t检验,比较有S/R和无S/R的入院前/多次入院.计算一元和多元二元逻辑回归模型。
结果:S/R的总比例为12.8%(n=100)。女性(p=0.001),家庭外护理患者(p<0.001),与先前入院(p<0.001),创伤后应激障碍(PTSD;p<0.001)和边缘性人格障碍(BPD;p<0.001)的S/R风险显着升高。以天为单位的停留时间(OR1.01),脱离家庭护理(OR3.85),PTSD(OR6.20),BPD(或15.17),注意缺陷多动障碍(ADHD)/品行障碍(OR4.29),在多因素回归分析中,躁狂发作/双相障碍(OR36.41)与S/R显著相关。
结论:儿童和青少年精神科工作人员在采取强制措施时应考虑危险因素。PTSD和/或BPD患者是最脆弱的亚组。需要对专业人员和临床实践进行培训,以防止使用S/R及其潜在危害。
To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Identifying preventative mechanisms through risk stratification upon inpatient admission can aid the training of mental health professionals, and support shaping specific workflows for at-risk populations for example by joint crisis plans or post-coercion review sessions.
METHODS: A
case-control study included all admissions (n = 782) to a department of child and adolescent psychiatry within 36 months between 2019 and 2022. Data on age, sex, out of home care, primary and comorbid ICD-10 diagnoses, length of stay, prior/multiple admissions were compared between admissions with and without S/R using chi square tests for categorical and t-tests for continuous variables. Uni- and multivariate binary logistic regression models were computed.
RESULTS: The overall proportion of S/R was 12.8% (n = 100). Females (p = 0.001), patients in out of home care (p < 0.001), with prior admission (p < 0.001), Post-traumatic stress disorder (PTSD; p < 0.001) and Borderline personality disorder (BPD; p < 0.001) were at a significantly higher risk of S/R. Length of stay in days (OR 1.01), out of home care (OR 3.85), PTSD (OR 6.20), BPD (OR 15.17), Attention deficit hyperactivity disorder (ADHD)/conduct disorder (OR 4.29), and manic episode/bipolar disorder (OR 36.41) were significantly associated with S/R in multivariate regression.
CONCLUSIONS: Child and adolescent psychiatric staff should consider risk factors when using coercive measures. Patients with PTSD and/or BPD are the most vulnerable subgroups. Training of professionals and clinical practice need to be adapted in order to prevent the use of S/R and its potential hazards.